Invest Clin 63(2): 163 - 169, 2022 https://doi.org/10.54817/IC.v63n2a06
Corresponding Author. Ersin Çelik. Clinic of Cardiovascular Surgery, Isparta Şehir Hastanesi, Sanayi Mahallesi
Atatürk Bulvarı No:51 Isparta, Turkey. E-mail: dr.ersincelik@gmail.com
Concomitant acute lower extremity arterial
and deep vein thrombosis developing in a
patient under anticoagulant therapy after
COVID 19 infection.
Ersin Çelik and Ahmet Rıfkı Çora
Clinic of Cardiovascular Surgery, Isparta City Hospital, Isparta, Turkey.
Key words: Covid 19; thrombosis; hypercoagulability; thromboprophylaxis.
Abstract. The hypercoagulable state continues after the Coronavirus 2019
(Covid 19) infection and prophylactic anticoagulants are recommended in this
period. However, arterial and venous thromboembolic events can be observed
during the convalescence period after the Covid 19. Here, we present the case
of acute lower extremity arterial and venous thromboembolism developed in
the post-Covid 19 period in a 77-years-old patient, under therapeutic doses of
anticoagulant therapy (enoxparin 1mg/kg of weight every 12 hours). The pa-
tient, who had no previous history of arterial or venous thrombosis, was taken
to emergency surgery with the diagnosis of ALI (acute limb ischemia) due to
acute arterial thrombosis. An arterial thrombectomy was performed with the
help of a 4F Fogarty catheter inserted from the left femoral artery under local
anesthesia. All distal pulses of the patient were palpable in the postoperative
period. After the platelet count became >100,000 mm3, 100 mg of acetylsali-
cylic acid daily was added to the therapeutic dose of enoxaparin sodium treat-
ment. The patient was discharged, uneventfully, except for a minimal diameter
increase secondary to deep venous thrombosis (DVT) on the fifth postoperative
day, with a combination of enoxaparin and acetylsalicylic acid treatment. En-
dothelial injury, chronic immuno-thrombogenicity, and increased platelet ag-
gregation in the post-Covid 19 recovery period can cause major thrombotic
events, even weeks after the recovery. Anticoagulant therapy is recommended
for thromboprophylaxis when the following statuses exist: ≥65 years, critical
illness, cancer, prior VTE, thrombophilia, severe immobility, and elevated D-
dimer. Combination treatment with long-term antiaggregant therapy may be
prudent in thromboembolic events developed under anticoagulant therapy.
164 Çelik and Rıfkı Çora
Investigación ClÃnica 63(2): 2022
Trombosis arterial aguda y trombosis venosa profunda
concomitantes de extremidad inferior en un paciente bajo
terapia anticoagulante después de infección por COVID 19.
Invest Clin 2022; 63 (2): 163 – 169
Palabras clave: COVID 19; trombosis; hipercoagulabilidad; tromboprofilaxis.
Resumen. El estado de hipercoagulabilidad continúa después de la infec-
ción por Coronavirus 2019 (Covid-19) y la anticoagulación profiláctica se reco-
mienda durante este perÃodo. Sin embargo, eventos tromboembólicos arteriales
y venosos se pueden observar durante el perÃodo de convalecencia posterior al
Covid-19. Se presenta el caso de trombosis venosa profunda (TVP) y arterial
agudas de una extremidad inferior en una paciente de 77 años, bajo terapia
anticoagulante (enoxparin 1mg/kg de peso, cada 12 horas), en el perÃodo post-
Covid 19. La paciente, sin historia previa de trombosis arterial ni venosa, fue
llevada a cirugÃa de emergencia con el diagnóstico de isquemia aguda de extre-
midades por trombosis arterial aguda. Se le realizó trombectomÃa arterial con
la ayuda de un catéter Fogarty 4F insertado desde la arteria femoral izquierda
bajo anestesia local. Todos los pulsos distales del paciente fueron palpables en
el periodo postoperatorio. Después de que las plaquetas llegaron a ser mayores
a100.000 mm3, 100 mg de ácido acetilsalicÃlico diarios se añadieron a la dosis
terapéutica del tratamiento con enoxaparina sódica. La paciente fue dada de
alta sin incidencias, excepto por un mÃnimo aumento de diámetro secundario
a la TVP, al quinto dÃa postoperatorio con la combinación de enoxaparina y
ácido acetilsalicÃlico. La lesión endotelial, la inmunotrombogenicidad crónica
y la agregación plaquetaria aumentada en el perÃodo de recuperación posterior
a Covid-19 pueden causar eventos trombóticos importantes incluso semanas
después de la recuperación. La combinación con terapia antiagregante a largo
plazo puede ser prudente en los casos de eventos tromboembólicos desarrolla-
dos en pacientes con terapia anticoagulante.
Received: 20-02-2022 Accepted: 20-03-2022
INTRODUCTION
Due to Coronavirus 2019 (Covid 19)
infection, mostly pulmonary and cardiovas-
cular complications develop. It has been
demonstrated that patients with Covid 19 in-
fection are in a hypercoagulable state, which
causes arterial and venous thrombosis1. The
hypercoagulable state continues after Co-
vid 19, and long-term anticoagulant therapy
is recommended for its treatment 2. Acute
limb ischemia (ALI) and venous thrombo-
embolism are among the most common
vascular complications seen after Covid 19
infection 1,3. Especially in the patients that
develop ALI, high amputation and mortality
rates are reported 3.
Here, we present a case of concomitant
lower extremity arterial and venous throm-
bosis that developed under anticoagulant
therapy in the early period after Covid 19
infection. A written informed consent was